By Dolores Kong, Globe Staff, 02/26/99

The Institute of Medicine, a leading US health policy group, is seriously considering launching a review of studies that induce psychotic symptoms or that withdraw medication from people with mental illness, a top official said yesterday.

''It's something we are very interested in trying to be helpful on,'' said Susanne Stoiber, executive officer of the private nonprofit institute, created to serve as a health policy adviser under a congressional charter granted to the National Academy of Sciences.

The institute's interest coincides with a recommendation that the institute review the studies, made in November by a presidentially appointed bioethics commission. In making that recommendation, the commission cited a Globe series highlighting the ethical concerns raised by the research.

Considering the growing concern, Stoiber said, ''In the next year, I expect we will be undertaking some work on this subject,'' on the psychosis-inducing and medication-withdrawal studies as well as on the broader ethical questions raised by research involving people with mental illness.

The institute is a kind of scientific high court, which the federal government and private foundations contract with to examine health policy issues.

For instance, next month the institute is scheduled to weigh in on the medical use of marijuana. It has appointed a committee to tackle the issue of how organs are allocated to patients at transplant centers.

But some critics of the research questioned whether the institute is the right organization to review the psychosis-inducing and medication-withdrawal studies.

''It can't in any way be even a semblance of independent investigation,'' said Vera Hassner Sharav, president and co-founder of the Citizens for Care in Psychiatry and Research, a leading critic of such studies. ''That is so cynical. The very people who conduct these kinds of illness-exacerbation experiments are members of the IOM.''

Stoiber and another official defended the institute's process for protecting its objectivity.

''The way IOM approaches any study is to create a committee or study panel that is expert in the subject area but does not in fact have any people on it whose personal research or financial interests are at stake in the outcome of the study,'' Stoiber said. For instance, the new institute committee looking at organ allocation does not include transplant surgeons.

''So we spend a lot of time composing our committees to achieve that result, bringing together scientists and experts from a number of fields, whose views would be important in terms of having a balanced overall look at the issue,'' she said.

Richard J. Bonnie, a member of the institute's board of neuroscience and behavioral health and a University of Virginia law professor, said, ''The key about an IOM study is its independence.''

Another hurdle to having the institute do the review, however, is that it relies on outside funding for its reports, which range in cost from $400,000 to $800,000.

While the National Bioethics Advisory Commission recommended in its report to President Clinton that the US Department of Health and Human Services contract with the institute, Stoiber said the institute has not yet been contacted.

The institute says that if administration officials do not express interest, it would seek funding elsewhere for a review at least of the questions of testing the mentally ill, if not of psychosis-inducing and medication-withdrawal studies.

If administration officials ''feel that they are not ready to do this, or that they don't agree'' with the National Bioethics Advisory Commission, Stoiber said, the institute ''would talk with private sponsors to see whether or not we could gather support for a study without government participation.''

While the question of psychosis-inducing and medication-withdrawal studies also deserves an in-depth inquiry, she said, it might be more difficult to interest a private funder in such a specific topic. Another funding possibility would be to have Congress request the study and appropriate the money, Stoiber said.

This story ran on page A14 of the Boston Globe on 02/26/99.
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